Background: Although androgen deprivation therapy has known cardiovascular risks, it is unclear if its duration is related to cardiovascular risks. This study thus aimed to investigate the associations between gonadotrophin-releasing hormone (GnRH) agonist use duration and cardiovascular risks.Methods: This retrospective cohort study included adult patients with prostate cancer receiving GnRH agonists in Hong Kong during 1999-2021. Patients who switched to GnRH antagonists, underwent bilateral orchidectomy, had <6 months of GnRH agonist, prior myocardial infarction (MI), or prior stroke was excluded. All patients were followed up until September 2021 for a composite endpoint of MI and stroke. Multivariable competing-risk regression using the Fine-Gray subdistribution model was used, with mortality from any cause as the competing event.Results: In total, 4038 patients were analyzed (median age 74.9 years old, interquartile range (IQR) 68.7-80.8 years old). Over a median follow-up of 4.1 years (IQR 2.1-7.5 years), longer GnRH agonists use was associated with higher risk of the endpoint (sub-hazard ratio per year 1.04 [1.01-1.06], p = 0.001), with those
Background
This study aims to examine the associations between metformin use concurrent with androgen deprivation therapy (ADT) and mortality risks in Asian, diabetic patients with prostate cancer (PCa).
Methods
This study identified diabetic adults with PCa receiving any ADT attending public hospitals in Hong Kong between December 1999 and March 2021 retrospectively, with follow‐up until September 2021. Patients with <6 months of medical castration without subsequent bilateral orchidectomy, <6 months of concurrent metformin use and ADT, or missing baseline HbA1c were excluded. Metformin users had ≥180 days of concurrent metformin use and ADT, while non‐users had no concurrent metformin use and ADT or never used metformin. The primary outcome was PCa‐related mortality. The secondary outcome was all‐cause mortality. The study used inverse probability treatment weighting to balance covariates.
Results
The analyzed cohort consisted of 1971 patients (1284 metformin users and 687 non‐users; mean age 76.2 ± 7.8 years). Over a mean follow‐up of 4.1 ± 3.2 years, metformin users had significantly lower risks of PCa‐related mortality (weighted hazard ratio [wHR]: 0.49 [95% confidence interval, CI: 0.39–0.61], p < 0.001) and all‐cause mortality (wHR 0.53 [0.46–0.61], p < 0.001), independent of diabetic control or status of chronic kidney disease. Such effects appeared stronger in patients with less advanced PCa, which is reflected by the absence of androgen receptor antagonist or chemotherapy use (p value for interaction: 0.017 for PCa‐related mortality; 0.048 for all‐cause mortality).
Conclusions
Metformin use concurrent with ADT was associated with lower risks of mortality in Asian, diabetic patients with PCa.
Background
While immune checkpoint inhibitors (ICIs) are associated with elevated cardiovascular risks, evidence of any association between ICIs and myocardial infarction (MI) was scarce, especially in Asians.
Methods
Using prospectively collected population‐based data, this self‐controlled case series included patients prescribed an ICI between 1/1/2014 and 31/12/2020 in Hong Kong who had MI within January 1, 2013 to December 31, 2021. Incidence rate ratios (IRRs) for MI during and after ICI exposure were estimated, compared to the year before ICI initiation.
Results
Of 3684 identified ICI users, 24 had MI during the study period. MI incidence increased significantly in the first 90 days of exposure (IRR 3.59 [95% confidence interval: 1.31–9.83],
p
= 0.013), but not days 91–180 (
p
= 0.148) or ≥181 (
p
= 0.591) of exposure, nor postexposure (
p
= 0.923). Sensitivity analyses excluding patients with MI‐related death and incorporating extended exposure periods produced consistent results separately.
Conclusions
ICIs were associated with increased MI incidence in Asian Chinese patients during the first 90 days of use, but not later.
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